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OBJECTIVE: To compare the vestibular function and clinical aspects (vestibular and migraine symptoms) of patients divided into three groups-migraine without aura, migraine with aura, and chronic migraine-and a control group by using electronystagmography and a design questionnaire. STUDY DESIGN: Case-control study. SETTING: Tertiary referral center. PATIENTS: Women aged between 18 and 55 years diagnosed with migraine with aura, migraine without aura, or chronic migraine according to the International Classification of Headache Disorders ICHD-third edition; diagnosis was made by a headache specialist. The control group consisted of patients' family members and hospital employees without a personal history of headache. MAIN OUTCOME MEASURES: Application of a questionnaire regarding vestibular symptoms and their relation to migraine aspects. Assessment of the vestibular function by electronystagmography. RESULTS: This study evaluated 120 female patients. Dizziness was the most prevalent vestibular symptom in all the migraine groups, with higher prevalence in the episodic migraine with aura and chronic migraine groups. Phonophobia and photophobia during vestibular symptoms also had greater prevalence in the latter groups. Electronystagmography tests did not reveal differences among the groups, but clinical stratification showed that tests with mixed etiology abnormalities were more prevalent in the episodic migraine with aura and chronic migraine groups. CONCLUSION: The prevalence of vestibular symptoms in the migraine groups and the etiology of vestibular impairment highlight that migraine affects the vestibular system. Our findings suggest that symptom progression and vestibular impact are related to migraine chronicity and presence of aura.
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Migraña con Aura , Migraña sin Aura , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Mareo/etiología , Mareo/diagnóstico , Estudios de Casos y Controles , Vértigo , CefaleaRESUMEN
Football players frequently face the occurrence of non-contact injuries. Although there are likely multiple factors that contribute to increased risk of non-contact injury, it remains a challenge to correlate all these factors. However, it is not clear how much of individual training abilities may interfere in these events. As such, the primary aim of the present study was to determine whether the reduction of functional performance of the thigh in the isokinetic knee tests, anthropometric and morbid history can establish risk factors for lower-limb musculoskeletal injuries throughout the season. The incidence of injuries and odds ratios were calculated for suspected risk factors. Hamstring/Quadriceps conventional ratio outside of the safety range (55-64%) may be involved in the occurrence of non-contact muscle injuries and the risk for any musculoskeletal injuries in the lower extremities is 16 times higher when extensor peak of torque exceeds 10% and 12 times higher when flexor peak of torque difference was greater than 10%. This kind of evaluation can result in intervention programs that may decrease the risk of lower-limb musculoskeletal injuries. Based on these results we can establish a specific and individualized exercise program for each athlete and thus protect them during the season.
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Extremidad Inferior/lesiones , Medición de Riesgo/métodos , Fútbol/lesiones , Adolescente , Adulto , Antropometría , Prueba de Esfuerzo , Músculos Isquiosurales/lesiones , Músculos Isquiosurales/fisiología , Humanos , Rodilla/fisiología , Ligamentos/lesiones , Estudios Longitudinales , Extremidad Inferior/fisiología , Masculino , Acondicionamiento Físico Humano , Músculo Cuádriceps/lesiones , Músculo Cuádriceps/fisiología , Factores de Riesgo , Fútbol/fisiología , Muslo/fisiología , Lesiones de Menisco Tibial/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS: A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS: All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION: Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).
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Terapia por Ejercicio/métodos , Síndrome de Dolor Patelofemoral/terapia , Adolescente , Adulto , Fenómenos Biomecánicos , Femenino , Cadera , Humanos , Fuerza Muscular , Manejo del Dolor/métodos , Síndrome de Dolor Patelofemoral/fisiopatología , Recuperación de la Función , Método Simple Ciego , Adulto JovenRESUMEN
OBJECTIVES: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists' interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups. METHODS: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss' kappa and previously recorded data (n = 30). RESULTS: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters. DISCUSSION: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters. LEVEL OF EVIDENCE: 2c.
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BACKGROUND AND PURPOSE: Total knee arthroplasty (TKA) has become the gold standard to manage pain and disability associated with knee osteoarthritis (KOA). There are no clear criteria on to determine when or who should undergo TKA. The creation of a pre-operative profile that includes physical functional data may aid in the clinical decision-making for the timing of TKA. Aim 1: to observe the pre-operative functional profile of subjects with advanced KOA and to depict it according to gender. Aim 2: to assess the association between pain, self-reported and performance-based physical function outcomes. STUDY DESIGN: retrospective study. Physical functional data from 122 persons (89 women and 33 men) with end-stage KOA were obtained through a database. Data consisted of height, weight, 6-minute walk test (6MWT) and the deficit when compared with normative values, self-visual analogue scale (VAS) after 6MWT and Western Ontario and McMaster Universities Index (WOMAC). Descriptive statistics were used to report the observed data; student t-test and Mann-Whitney were used to compare gender groups. Spearman correlation was used to asses the association with the 6MWT, WOMAC and VAS. RESULTS: The mean (standard deviation) values of our sample for the WOMAC, 6MWT deficit and VAS were calculated. There was a significant difference between gender in the WOMAC score and pain intensity (VAS) after the 6MWT (p = 0.002; p = 0.01). Moderate to weak correlations between WOMAC score, VAS and 6MWT were found. Correlation values ranged from r = 0.23 to 0.48. CONCLUSION: The current study suggests a functional profile for subjects who are scheduled to undergo TKA. Our results show that the correlations of self-report and performance-based measures of function and reported pain are poor. This enhances the idea of using all of these types of measures to establish the functional profile a sample of subjects with advanced KOA. Copyright © 2015 John Wiley & Sons, Ltd.
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Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Dimensión del Dolor/métodos , Rango del Movimiento Articular/fisiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/rehabilitación , Brasil , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/rehabilitación , Cuidados Preoperatorios/métodos , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no Paramétricas , Resultado del TratamientoAsunto(s)
Empleos Relacionados con Salud/normas , Investigación Biomédica/normas , Becas/normas , Guías como Asunto/normas , Educación y Entrenamiento Físico/normas , Comités Consultivos , Empleos Relacionados con Salud/estadística & datos numéricos , Investigación Biomédica/estadística & datos numéricos , Brasil , Becas/estadística & datos numéricos , Educación y Entrenamiento Físico/estadística & datos numéricos , Investigadores/estadística & datos numéricos , Apoyo a la Investigación como AsuntoAsunto(s)
Empleos Relacionados con Salud/normas , Investigación Biomédica/normas , Becas/normas , Guías como Asunto/normas , Educación y Entrenamiento Físico/normas , Comités Consultivos , Empleos Relacionados con Salud/estadística & datos numéricos , Brasil , Investigación Biomédica/estadística & datos numéricos , Becas/estadística & datos numéricos , Educación y Entrenamiento Físico/estadística & datos numéricos , Apoyo a la Investigación como Asunto , Investigadores/estadística & datos numéricosRESUMEN
The Patellofemoral Pain Syndrome is one of the most common disorders of the knee, characterized by pain in the frontal part of the knee, which is worsened by activities that increase compressive forces on the joint. Alterations in the muscle strength of the quadriceps and hip stabilizer muscles can change patellar biomechanics, increasing joint stress and exacerbating pain symptoms. The aim of the study was to compare the strength of the hip and knee stabilizing muscles of women without and with Patellofemoral Pain Syndrome. The study included 45 women, 20 volunteers without the syndrome and 25 with Patellofemoral Pain Syndrome. Using an isometric dynamometer, the strength of the knee flexors and extensors, hip abductors and adductors, hip external rotators, medial rotators, hip flexors and hip extensors was evaluated. Women with Patellofemoral Pain Syndrome had 22% less strength of the internal rotators and 23% less strength of the knee extensors compared to healthy ones. As for the other muscle groups assessed, no differences were found. Therefore, the present study emphasizes that the quadriceps muscles are still the most affected muscle in individuals with the Patellofemoral Pain Syndrome.
El Síndrome de Dolor Patelofemoral es uno de los trastornos más frecuentes de la rodilla, caracterizado por dolor anterior en la rodilla, que se agrava con actividades que aumentan las fuerzas compresivas en la articulación. Alteraciones en el estándar de fuerza muscular del cuádriceps o de la musculatura estabilizadora del cuadril podrían cambiar la biomecánica de la articulación patelofemoral y así aumentar el estrés articular y exacerbar los síntomas de dolor. El objetivo de eso estudio fue relacionar la fuerza de la musculatura del cuadril y de la rodilla en mujeres con y sin el síndrome. Eso estudio incluyó 45 voluntarias, 20 sin y 25 con el Síndrome de Dolor Patelofemoral. La fuerza isométrica de los músculos flexores y extensores de la rodilla, abductores, aductores, flexores, extensores, rotadores laterales y mediales del cuadril fue evaluada por una célula de carga ajustada. Mujeres con el Síndrome de Dolor Patelofemoral presentaron reducción del 22% de la fuerza de los rotadores mediales de cuadril y un 23% de los extensores de la rodilla, cuando comparadas con las sin el Síndrome de Dolor Patelofemoral. No fueron observadas diferencias en la fuerza isométrica entre los otros grupos musculares. Por lo tanto, los datos de eso trabajo resaltan que la musculatura quadricipital y los rotadores mediales del cuadril son los más comprometidos en sujetos con el Síndrome de Dolor Patelofemoral.
A Síndrome da Dor Femoropatelar é uma das desordens mais frequentes do joelho, caracterizada por dor anterior no joelho, que se agrava com atividades que aumentam as forças compressivas na articulação. Alterações no padrão de força muscular do quadríceps ou da musculatura estabilizadora do quadril poderiam alterar a biomecânica da articulação femoropatelar e, assim, aumentar o estresse articular e exacerbar sintomas de dor. O objetivo deste estudo foi comparar a força da musculatura de quadril e joelho em mulheres com e sem tal síndrome. Participaram deste estudo 45 voluntárias, sendo 20 sem e 25 com a Síndrome da Dor Femoropatelar. A força isométrica dos músculos flexores e extensores de joelho, abdutores, adutores, flexores, extensores, rotadores laterais e mediais do quadril foi avaliada por uma célula de carga adaptada. Mulheres com Síndrome da Dor Femoropatelar apresentaram redução de 22% da força dos rotadores mediais de quadril e 23% dos extensores de joelho, em comparação àquelas sem a Síndrome da Dor Femoropatelar. Não foram observadas diferenças na força isométrica entre os outros grupos musculares. Portanto, os dados deste trabalho reforçam que a musculatura quadricipital e os rotadores mediais do quadril são os mais comprometidos em indivíduos com Síndrome da Dor Femoropatelar.
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Humanos , Femenino , Articulación de la Cadera , Articulación de la Rodilla , Fuerza Muscular , Músculo Cuádriceps/fisiología , Síndrome de Dolor Patelofemoral , Brasil/etnología , Estudios Transversales , Extremidad Inferior/lesionesAsunto(s)
Humanos , Persona de Mediana Edad , Anciano , Vendajes , Osteoartritis de la Rodilla/terapia , Equilibrio Postural , Presión , PropiocepciónRESUMEN
Objetivo: Como a síndrome da dor patelofemoral (SDPF) é uma desordem comum, caracterizada por etiologia multifatorial e o mais prevalente sintoma na SDPF é uma dor difusa e usualmente localizada na região retropatelar, entretanto, com sinais e sintomas que podem estar relacionados como pronação subtalar excessiva, torsão tibial externa, alterações no deslocamento patelar, amplitude de movimento do joelho dolorosa, dor nas bordas patelares, tensão muscular e alterações no ângulo quadricipital (ângulo Q). O objetivo deste trabalho foi verificar a frequência destes sinais e sintomas associados a um questionário de dor anterior no joelho. Métodos: Trinta e nove voluntárias sedentárias foram avaliadas, divididas em dois grupos, SDPF (19) e controle (20). Estas voluntárias foram avaliadas quanto aos sinais e sintomas supracitados além da avaliação da dor por meio de questionário. Resultados: os resultados demonstraram uma frequência elevada de relatos dolorosos em seis de treze questões, em relação ao grupo controle. Conclusão: De acordo com estes achados, concluímos que a avaliação funcional de indivíduos com SDFP deve ser constituída de um questionário de dor anterior no joelho e uma avaliação das características de sinais e sintomas para exame de todo o membro inferior estático e durante situações funcionais. Nível de Evidência II, Estudos Diagnósticos.
Objective: As patellofemoral pain syndrome (PFPS) is a common disorder characterized by multifactorial etiology and whose the most prevalent symptom is a diffuse pain, usually located on the retropatellar region, however, it also shows signs and symptoms that can be related as excessive subtalar pronation, external tibial torsion, patellar displacement alterations, painful range of motion of the knee, pain in the patellar borders, muscular tightness and changes in quadriceps angle (Q Angle), the objective of this work was to determine the frequency of these signs and symptoms associated to a previous knee pain questionnaire. Methods: thirty-nine sedentary female volunteers had been evaluated, divided in two groups, PFPS (19) and Control (20). These subjects were evaluated for signs and symptoms described above, in addition to pain assessment by questionnaire. Results: the results demonstrated a high frequency of pain in six of the thirteen questions in relation to the control group. Conclusion: according to these findings, we conclude that the functional evaluation of individuals with PFPS should consist of a previous knee pain questionnaire and an evaluation of the characteristic signs and symptoms for examination of the entire lower limb during static and functional situations. Level of Evidence II, Diagnostic Studies.
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Humanos , Masculino , Femenino , Articulación de la Rodilla/fisiopatología , Dimensión del Dolor , Signos y Síntomas , Síndrome de Dolor Patelofemoral/diagnóstico , Síndrome de Dolor Patelofemoral/terapia , Grupos Control , Encuestas y Cuestionarios , Conducta SedentariaRESUMEN
OBJECTIVE: As patellofemoral pain syndrome (PFPS) is a common disorder characterized by multifactorial etiology and whose the most prevalent symptom is a diffuse pain, usually located on the retropatellar region, however, it also shows signs and symptoms that can be related as excessive subtalar pronation, external tibial torsion, patellar displacement alterations, painful range of motion of the knee, pain in the patellar borders, muscular tightness and changes in quadriceps angle (Q Angle), the objective of this work was to determine the frequency of these signs and symptoms associated to a previous knee pain questionnaire. METHODS: Thirty-nine sedentary female volunteers had been evaluated, divided in two groups, PFPS (19) and Control (20). These subjects were evaluated for signs and symptoms described above, in addition to pain assessment by questionnaire. RESULTS: The results demonstrated a high frequency of pain in six of the thirteen questions in relation to the control group. CONCLUSION: According to these findings, we conclude that the functional evaluation of individuals with PFPS should consist of a previous knee pain questionnaire and an evaluation of the characteristic signs and symptoms for examination of the entire lower limb during static and functional situations. Level of Evidence II, Diagnostic Studies.
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OBJECTIVE: To estimate the pressure pain threshold (PPT) of the craniocervical muscles in women with episodic migraine (EM) n=15 and chronic migraine (CM) n=14, and in healthy volunteers (C) n=15. METHOD: A blinded examiner obtained the PPT bilaterally, by pressure algometry, for the following muscles: frontalis, temporalis, masseter, trapezius and sternocleidomastoid. ANOVA (p<0.05) was used for statistical purposes. RESULTS: Contrasted to controls, individuals with EM had significantly decreased PPT values for frontal muscle (EM: 2.01±0.67 vs. C: 2.85±0.71), posterior temporalis bilaterally (right and left, respectively) (EM: 2.72±0.89 vs. C: 3.36±0.72 and EM: 2.60±1.00 vs. C: 3.35±0.85), upper trapezius bilaterally (EM: 2.69±1.00 vs. C: 3.49±0.83 and EM: 2.54±0.93 vs. C: 3.32±0.97) and women with CM: on frontal muscle bilaterally (CM: 2.16±0.52 vs. C: 2.79±0.71 and CM: 2.01±0.67 vs. C: 2.85±0.71) and upper trapezius (CM: 2.66±0.84 vs. C: 3.32±0.97), however, it was not verified differences between PPT values between EM and CM groups. CONCLUSION: PPT is decreased in women with migraine relative to controls. Future studies should explore this parameter as a biological marker of the disease and a predictor of treatment.
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Trastornos Migrañosos/fisiopatología , Músculos del Cuello/fisiopatología , Umbral del Dolor/fisiología , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Electromiografía , Femenino , Humanos , Persona de Mediana Edad , Músculos del Cuello/fisiología , Músculo Temporal/fisiologíaRESUMEN
OBJECTIVE: To estimate the pressure pain threshold (PPT) of the craniocervical muscles in women with episodic migraine (EM) n=15 and chronic migraine (CM) n=14, and in healthy volunteers (C) n=15. METHOD: A blinded examiner obtained the PPT bilaterally, by pressure algometry, for the following muscles: frontalis, temporalis, masseter, trapezius and sternocleidomastoid. ANOVA (p<0.05) was used for statistical purposes. RESULTS: Contrasted to controls, individuals with EM had significantly decreased PPT values for frontal muscle (EM: 2.01±0.67 vs. C: 2.85±0.71), posterior temporalis bilaterally (right and left, respectively) (EM: 2.72±0.89 vs. C: 3.36±0.72 and EM: 2.60±1.00 vs. C: 3.35±0.85), upper trapezius bilaterally (EM: 2.69±1.00 vs. C: 3.49±0.83 and EM: 2.54±0.93 vs. C: 3.32±0.97) and women with CM: on frontal muscle bilaterally (CM: 2.16±0.52 vs. C: 2.79±0.71 and CM: 2.01±0.67 vs. C: 2.85±0.71) and upper trapezius (CM: 2.66±0.84 vs. C: 3.32±0.97), however, it was not verified differences between PPT values between EM and CM groups. CONCLUSION: PPT is decreased in women with migraine relative to controls. Future studies should explore this parameter as a biological marker of the disease and a predictor of treatment.
OBJETIVO: Estimar os valores de limiar de dor por pressão (LDP) dos músculos craniocervicais de mulheres com migrânea episódica (ME) n=15 e crônica (MC) n=14, e em voluntários controles saudáveis (C) n=15. MÉTODO: O LDP foi obtido bilateralmente por examinadores cegos através da algometria de pressão nos seguintes músculos: frontal, temporal, masseter, trapézio e esternocleidomastóideo. Para análise estatística foi utilizada a ANOVA (p<0.05). RESULTADOS: Em relação aos controles, pacientes com ME apresentaram redução significativa do LDP para os músculos: frontal (ME: 2,01±0,67 vs. C: 2,85±0,71), temporal posterior bilateralmente (direito e esquerdo, respectivamente) (ME: 2,72±0,89 vs. C: 3,36±0,72 e ME: 2,60±1,00 vs. C: 3,35±0,85), trapézio superior bilateralmente (ME: 2,69±1,00 vs. C: 3,49±0,83 e ME: 2,54±0,93 vs. C: 3,32±0,97) e mulheres com MC: no músculo frontal bilateralmente (MC: 2,16±0,52 vs. C: 2,79±0,71 e MC: 2,01±0,67 vs. C: 2,85±0,71) e trapézio superior (MC: 2,66±0,84 vs. C: 3,32±0,97). Entretanto não foram verificadas diferenças entre os valores de LDP entre os grupos ME e MC. CONCLUSÃO: O LDP mostrou-se reduzido em mulheres com migrânea episódica ou crônica em relação aos controles. Em estudos futuros, esse parâmetro pode ser estudado como marcador da migrânea e indicador de efeito de tratamento.